Dual Diagnosis: The Connection Between Addiction & Mental Illness

Posted by Sarah Edwards on Jul 9, 2018 8:00:00 AM


Not long ago, there was a hard line drawn between two conditions: mental health and addiction. They were looked at as two separate issues that were unrelated. Today, the 21st Century recognizes that these two are more connected than once realized. In order to properly treat mental illness and addiction, we need to understand how they affect an individual.


What is Dual Diagnosis

When someone struggles with addiction problems simultaneously with being diagnosed with a mental illness such as depression, bipolar, or anxiety, it is called “dual diagnosis.” Either one can develop first to be considered dual diagnosis or “co-occurring disorder.” Many who suffer from a mental illness will attempt to cope with their illness by self-medicating with drugs or alcohol. Self-medicating is where a person will use drugs or alcohol to cover up or mask their mental illness symptoms. However, research shows that drugs and alcohol can make mental illness symptoms worse. This creates a vicious cycle of mental illness symptoms and drug or alcohol abuse.

On their own, both addiction and mental illnesses alone make maintaining a stable life difficult, but when the two are combined, it makes the situation even more complicated. “When a mental health problem goes untreated, the substance abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too,” states HelpGuide.org.When these problems are ignored, they do not get better on their own. Professional treatment is the route to stability and happiness.

A 2014 National Survey on Drug Use and Health showed that 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. Of those Americans, more than half of them or around 4.1 million, are men. Also, the NSDUH found that 45 percent of people with addiction had a co-occurring mental illness.

Some mental illnesses that are linked to substance abuse include:

  • Depression - The Anxiety and Depression Association of America has found that major depressive disorder affects over 16.1 million Americans. Many of these people will seek out drugs or alcohol to self-medicate. Unfortunately, this only makes the problem worse by increasing the crash after the high.

  • Anxiety - Anxiety disorders are the most common mental health disorders in America today. This group is likely to use drugs or alcohol to manage their symptoms. Many times, people diagnosed with an anxiety disorder will be given a prescription for benzodiazepines. Benzodiazepines are highly addictive and might lead to a person abusing them.

  • Bipolar Disorder - This disorder is characterized by episodes of both depression and mania. About half of those diagnosed with bipolar disorder also have problems with addiction. Drugs and alcohol can provide a temporary comfort from these episodes. However, they do not last and can quickly turn into addiction.

  • Post-traumatic Stress Disorder - Post-traumatic stress disorder or PTSD is where the brain produces significantly fewer endorphins after a traumatic event than a healthy brain. To feel “normal” again, those with PTSD will look to alcohol or drugs for relief. Drugs and alcohol can also be a means of escaping traumatic memories.

A close up of a doctors coat and pocket-Doctors diagnose dual diagnosis cases very often.


Causes of Dual Diagnosis

Researchers are attempting to find out why addiction and mental health issues can occur together. Several aspects come into play when it comes to answering this question. According to the Addiction Center, “A number of overlapping factors can aggravate a mental health or a substance abuse disorder.” For example:

  • Genetics - A person’s genetic makeup can predetermine a person’s likelihood of developing an addiction or mental disorder. A person’s susceptibility to addiction is made up of 40 to 60 percent of their genes.

  • How a Brain Responds - When you abuse drugs, you can elicit symptoms that mimic a mental illness. For instance, when a person gets high, they might hallucinate. Hallucinations are a symptom of psychotic disorder like schizophrenia.

  • Environmental Triggers - When we say “environment,” we mean a person’s immediate surroundings such as home life, work life, or community life. It is here where outside stress or trauma can kickstart a mental illness or addiction.

  • Early Exposure - People who experiment with drugs or alcohol in early adolescence have a higher chance of developing an addiction or mental illness. It has been proven that teenagers and young adults are more prone to brain damage than older adults.


The signs of dual diagnosis vary greatly between the people who have been diagnosed with it. Co-occurring disorders can be difficult to diagnose because the symptoms of substance abuse or dependence can mask the symptoms of a mental illness, and vice versa. Generally, it will depend on what the mental illness is and what the addiction is along with the severity of each. Foundations Recovery Network gives some red flags that you or a loved one may be battling with dual diagnosis:

  • Abandoning friends or family in favor of new activities or a new crowd
  • Struggling to keep up with school or work
  • Lying or stealing in order to continue an addictive behavior
  • Staying up late at night and sleeping during the day
  • Trying to quit using drugs, drinking, gambling or having unsafe sex, but relapsing repeatedly
  • Expressing feelings of guilt or regret about a compulsive behavior
  • Seeking out larger doses of drugs, more alcoholic beverages or more extreme high-risk behavior in order to get the same high
  • Experiencing withdrawal symptoms after trying to quit a harmful substance or cutting down the dose



Many times, denial is a common behavior in those that have been diagnosed with a co-occurring disorder. It is easy to not realize you need help when a mental illness is influencing your own thoughts and perceptions. For example, anxiety may make you want to hide from other people and depression can make you feel unworthy of treatment. These symptoms of mental illness may become so unbearable that alcohol and drugs feel like the only option to cope. When you begin to use drugs or alcohol to ease the symptoms of mental illness, you risk becoming addicted

Or, you may find yourself relieved to be diagnosed with a mental illness and finally get an answer to the question of why you are feeling and behaving the way that you do. If you can put a name to your illness, then the next step is treatment. Sometimes reaching out can be the hardest but most crucial step.

Treatment for Dual Diagnosis

According to Morteza Khaleghi Ph.D., “Dual Diagnosis emerged as a concept over 20 years ago, but unfortunately is still not well understood by the medical establishment though it is quite simple.” Some in the medical community believe that dual diagnosis can be treated one of two ways: sequentially or separately. When it is solved sequentially, first the addiction is treated and then the underlying mental health issues that provoked the addiction. This type of treatment has been phased out since it showed that there was a higher chance of relapse. When it is solved separately, the addiction and the mental illness are treated at the same time by different doctors. Therefore, both issues are being addressed simultaneously which heightens the chance of recovery.


When only one illness is treated, there is a higher chance of relapse. Both illnesses need to be addressed together since they are intertwined. If they are treated at the same time, there is a better opportunity for a lasting recovery. Dual diagnosis blends the most successful aspects of addiction treatment along with mental health treatment. “To provide appropriate treatment for co-occurring disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services recommends an integrated treatment approach. Integrated treatment is a means of coordinating substance abuse and mental health interventions, rather than treating each disorder separately and without consideration for the other,” says Psychology Today.

If you are diagnosed with a mental illness along with an addiction problem, you will most likely be prescribed medication as part of your treatment plan. You and your doctor might take some time to figure out which medication(s) are right for you. Each psychiatric medication is different and affects different people differently. It is important to be honest with your doctor providing dual diagnosis addiction treatment about how the medication makes you feel.

Stay away from alcohol while taking psychiatric medication. Mixing medication for mental illness with alcohol has serious consequences. The medication might become less effective or cause harmful side effects if it is taken with alcohol. Antidepressants and anti-anxiety medications are known for interacting negatively with alcohol. Also, taking medication for a mental illness is not a sign of weakness or cop out.

Along with medication, talk therapy with a professional such as a therapist or counselor will help you develop the skills to deal with personal issues properly without relapsing and relying on drugs or alcohol. Coping skills are an important part of your journey to recovery. They are tools that you keep with you when some of the same problems start to arise. A therapist can offer emotional support as you get accustomed to a sober life.

There is no single treatment option that works for everyone with a dual diagnosis. There are so many different combinations of drugs, alcohol, and mental illnesses that can come together to form unique dual diagnosis in one person. Because of this, it may get frustrating trying to find the correct combination of medication and therapy to help you recover. However, do not give up hope because there are so many options for treatment including residential treatment or outpatient.

After Treatment

You may be wondering if it is possible to stay sober after being in rehab for dual diagnosis. It is possible. There are steps you can take to stay on the path to recovery. You can participate in your recovery by continuing therapy either in a group or individually. Being able to talk about your recovery and your progress keeps you on track. Make sure to take the medications the way your doctor prescribed them. Get good sleep, eat well, and exercise. Also, an effective way to stay sober is by having a structured lifestyle. When there is structure in your life, there leaves little room for impulsiveness. Finally, if you notice any changes in your thought, mood, or health, contact a member of your support team such as your therapist or doctor.


With any recovering drug addict or alcoholic, there is the possibility of relapse. If you do end up relapsing, do not feel guilty about it. However, this may be difficult to deal with. According to Psychology Today, “Addiction is common with as many as 90% of patients stumbling post-treatment.” However, being sober and healthy is a lifelong process that takes work. Staying involved in either group therapy or individualized therapy is important. This way, if you are going through a difficult time, you can have the opportunity to seek help from a professional instead of turning back to drugs or alcohol. Ultimately, your dual diagnosis adds that extra layer to your addiction since they fuel each other.


According to the National Institute on Drug Use, about 80 percent of people who are sober five years after treatment tend to stay that way for good. It’s important to remember that one slip up does not have to mean that you will descend back into your old lifestyle. In fact, it may help you grow in your sobriety and give you a healthy perspective on yourself and your situation. The Foundations Recovery Network says it best, “The key is to forgive a tiny slip and to get right back on the path to sobriety as soon as possible. That way, the downward slide is stopped, and the person can continue to lead a happy, healthy, addiction-free life.”



Next Steps

If you or your loved one is dealing with an addiction, please contact Landmark Recovery for the best drug and alcohol recovery. Our experienced staff, welcoming environment, and diverse treatment programs all work together to give you the best in a recovery facility.



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Topics: Addiction

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